Download Abnormalities of conceptus` development. Multifetal pregnancy

BUKOVINIAN STATE MEDICAL UNIVERSITY
“Approved”
First Pro-rector
Professor________________ M. Y. Kolomoyets
“___”______________________ 200_ year
Reference-book For Student
Obstetrics and Gynecology
______________________
(Structure, aim, maintenance of discipline, checking questions)
“Approved” on methodological meeting of Department of Obstetrics and
Gynecology with the Course of Infant and Adolescent Gynecology
“___”______________________ 200_ year (protocol # )
T.a. as the Head of the Department of Obstetrics and Gynecology with the Course
of Infant and Adolescent Gynecology
Professor________________ O.A. Andriyets
“Approved” on methodological meeting of Pediatric discipline of Obstetrics and
gynecology
“___”______________________ 200_ year (protocol # )
The Head of PMK
Professor________________ O.V. Kravchenko
Chernivtsi – 2008
Obstetrics and Gynecology
Standard discipline
1. Introduction
Lections
– 10 h
Practical studies
– 40 h
Independent work
– 40 h
Maintenance of discipline is structured for 1 module and 2 contents module.
1. The Structure of discipline Obstetrics and Gynecology
MODULE 1: Physiology of pregnancy, labor and puerperium
CONTEXT MODULE 1: Physiology of pregnancy, labor and puerperium
CONTEXT MODULE 2: Perinatology. Risk factors of perinatal period
MODULE 2: Pathology of pregnancy, labor and puerperium
CONTEXT MODULE 3: Pathology of pregnancy, labor and puerperium
MODULE 3: Family planning.
CONTEXT MODULE 4: Endocrine disorders of women’s reproductive
system.
CONTEXT MODULE 5: Principles of oncogynecology.
CONTEXT MODULE 6: Inflammation diseases of women’s reproductive
system.
CONTEXT MODULE 7: Family planning.
MODULE 4: Obstetrics and Gynecology
CONTEXT MODULE 8: Physiological obstetrics.
CONTEXT MODULE 9: Pathology of pregnancy and labor.
CONTEXT MODULE 10: Perinatal pathology.
CONTEXT MODULE 11: Physiology of pregnancy, labor and puerperium
CONTEXT MODULE 12: Gynecological diseases
CONTEXT MODULE 13: Family planning
The curriculum description on discipline obstetrics and gynecology for
students of medical faculties who study the obstetrics and gynecology on a
speciality 7.110101
Subject matter
structure
Quantity of hours, from them
In all
auditorium
ISW
Study
year
Control
lections
Practical
training
450/ 15
30
220
200
4-6
10
40
40
4
10
40
40
4
module 2:
Context
modules 1
90 h. / 3,0
credits
ЕСТS
90 h. / 3,0
credits
ЕСТS
60 h. /
2,0 credits
ЕСТS
10
30
20
5
Line and final
modular
control
module 3:
Context
modules 4
75 h. /
2,5 credits
ЕСТS
10
40
25
5
Line and final
modular
control
Total for the 5
study year
135 h./
4,5 credits
ЕСТS
225 h. / 7,5
credits
credits
ЕСТS
225 h. / 7,5
credits
ЕСТS
20
70
45
5
110
115
6
110
115
6
hours/
credits ЕСТS
module 1:
context module
2
Total for the 4
study year
module 4:
Context
modules 3
Total for the 6
study year
Line and final
modular
control
Line and final
modular
control
MODULE 1: Physiology of pregnancy, labor and puerperium
4.1. Theme’s Plan of Lectures
№
1.
2.
3.
4.
5.
6.
Theme
Organization of Obstetric and Gynecological center
Physiology of pregnancy. Perinatal care of fetus.
Physiology of labor. Anesthesia in labor.
Multifetal pregnancy
Placentary insufficiency. Hypoxia (acute and chronic). Retardation,
hypotrophia.
Pharmacotherapy in obstetrics. Questions of medical ethics and
deontology. Pharmacokinetics and fharmacodynamics of medical
drugs.
Total
Quan/
h
2
2
2
1
2
1
10
4.2. Theme’s Plan of practical classes
№
1.
2.
3.
4.
5.
6.
7.
8.
9.
Theme
Bone Pelvis. Fetus as an object of labor.
Physiology of pregnancy. Perinatal care of fetus. Methods of
examination of pregnant women. Obstetrics terminology
Physiology of labor. Anesthesia in labor.
Physiology of puerperium. Physiology of newborn.
Breech presentation. Malpresentations. Contracted pelvis
Abnormalities of conceptus’ development. Multifetal pregnancy.
Malpresentations of fetus.
Diagnostic methods of well-being of fetus. Placental insufficiency.
Rh-izoimmunisation of fetus. Disorders of neonatal period. Asphyxia
of the newborn. Methods of resuscitation of the infants.”
Defense of educational history of labor.
Quan/h
4
4
4
4
4
4
4
4
4
Final modular control I.
4
Total
40
4.3. Theme’s Plan of Independent students work (ISW)
№
Quan/h
Control
Preparation for the practical classes and
lections
Working on topics which are not included in
plan of practical classes
31
Line modular control
on practical classes
Final modular control
3.
Individual independent work
2
Final modular control
4.
Preparation for the Final modular control
Total hours
7
40
Final modular control
1.
2.
Kind of ISW
-
LIST OF INDIVIDUAL TASKS













Writing the abstract «Physiology changes in the organs of the
cardiovascular system and breathing system during pregnancy».
Writing the abstract «Physiology changes in the organs of gastric tract
during pregnancy».
Writing the abstract «Physiology changes in the organs of the kidney
system during pregnancy».
Writing the abstract «Physiology changes in the organs of blood system
and endocrine system during pregnancy».
Writing the abstract «Anesthesia in labor».
Writing the abstract «Causes of labor start».
Writing the abstract «Modern aspects of conduct of multifetal
pregnancy».
Writing the abstract «Estimation of the fetus well-being basing on
cardiotokography».
Writing the abstract «Biophysical type of fetus».
Writing the abstract «Dopplerometric characteristics of the fetus’ wellbeing»
Writing the abstract «Sepsis of the newborn».
Writing the abstract « “Diagnostic and treatment of retardation of fetus».
Writing the abstract «Antenatal pneumonia».


Writing the abstract «Macrosomia of fetus».
Writing the abstract «Trophoblast diseases».
LIST OF QUESTIONS FOR STUDENTS’ PREPARATION TO CURRENT
AND FINAL MODULE CONTROL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Organization of obstetric-gynaecological aid. Medico-actuarial science. A
question of health protection maternity and childhood is in the modern
legislation of Ukraine.
Structure and principles of work of maternity hospital. Basic indexes of
work of obstetric hospital.
A role of female consultation in the prophylaxis of complications of
pregnancy and labor, perinatal care of fetus.
Female consultation and its role is in a prophylaxis, diagnostics and
treatment of gynaecological diseases.
Influence of harmful factors on menstrual and reproductive functions.
Consultation on «Marriage and family». Medico-genetic consultation, its
functions. Family planning.
Psychological preparation of woman before labor.
Farmacotherapy in obstetrics, influence of medications on a fetus.
Medical deontology in obstetrics and gynecology. Ethics of doctor.
Ways of passing AIDS, ТORCH-infections and methods of their
prophylaxis.
External and internal female genitalia.
Blood delivery and lymphatic systems of female genitalia.
Physiology changes are in the female sexual system in different age-old
periods.
A modern picture of the neuro-endocrine regulation of menstrual function.
Structure of female pelvis. Pelvis from the obstetric point of view.
Fetus as an object of labor (sizes of head, sutures, fontanels).
Structure of gametes. Impregnation and development of fetus. Implantation.
Placentation. Organogenesis. Development of fetal shells.
Methods of examination of pregnant. External and internal obstetric
examination of pregnant. Obstetric terminology.
Diagnostics of early terms of pregnancy.
Diagnostic of late terms of pregnancy.
Viability and maturity of fetus.
Periods of labor.
Biomechanism of labor in anterior and posterior occipital presentations.
Period of cervical effacement in labor. Clinical flow and management.
Non-medical anesthesia in labor.
Period of pushing efforts. Clinical flow and management.
Perineal protection maneuvers.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
Placental period (the third period of labor). Clinical flow and management.
Signs of placental separation.
Physiological separation of placenta.
Conservative methods of separation of placenta.
Methods of estimation of after-birth condition of placenta. Physiological and
pathological blood loss.
Clinical flow and management of puerperium.
Changes in maternal organism during puerperium.
Aseptic in obstetrics.
Multifetal pregnancy. Collision of twins.
Prophylaxis of complications of multifetal pregnancy.
Classification of breech presentation.
Biomechanism of delivery in case of breech presentation.
Management of the delivery in case of breech presentation. Classical aid.
Aid by Tsovyanov (I and II).
Anatomically and clinically contracted pelvis.
Classification of pelvis’ contraction.
Features of flow of pregnancy and delivery in case of contracted pelvis.
Features of biomechanism of labor in case of different forms of contracted
pelvis.
Labor and large fetus. Etiology. Methods of diagnostics. Complications in
labor.
Circulation of blood as an element of the functional system of placenta and
fetus.
Functions of placenta. Biological role of amniotic fluid.
Methods of determination of the functional state of the placental system in
the different terms of pregnancy, in labor. Biopsy of chorion.
Amniocentesis. Cordocentesis.
Embryo and fetal periods of development. Blasto-, embrio- and fetopathy.
Diagnostics of defects of development of fetus in different periods of
pregnancy.
Perinatal pharmacology. Influence of strong medications and nicotine on a
fetus.
Immunological incompatibility of blood of mother and fetus (Rh-conflict,
etc).
Pathogenesis of immunological conflict, modern system of diagnostics and
treatment.
A conduct of pregnancy and determination of optimum term of births in case
of immunization of rhesus.
A conduct of post-natal period in case of immunological conflict.
Hemolytic disease of newborn. Diagnostics and treatment.
Placenta insufficiency. Classification. Diagnostics and therapy of placenta
insufficiency.
Modern methods of diagnostics of the fetus well-being.
Fetal retardation. Etiology, diagnostics and methods of treatment. Tactic of
59.
60.
61.
62.
63.
64.
65.
labor.
Methods of treatment of hypoxia of fetus.
An estimation of newborns according to scales of Apgar and Silverman.
Reanimation and intensive therapy of asphyxia of newborn.
Features of adaptation of pre-term newborns.
Hormonal crisis of newborn.
Infection toxic diseases of newborn.
Intrauterine infections of fetus. TORCH-infections.
Violation of function of lactation. Methods of correction.
Practical tasks
Practical tasks are to be fulfilled on practical class. They are aimed for better
learning of theoretical material of class and for practical application of gained
knowledge:
- anamnesis taking
- examination of pregnant
- development of plan of laboratory examination of pregnant
- interpretation of analyses and results of examination
- differential diagnostics of complications of pregnancy
- establishment of clinical diagnosis
- development of tactics of management of pregnancy and delivery
- giving the emergency care
- resolving the situational clinical sums
- training on practical skills on obstetric phantoms and on patients
- management of medical documentation
Practical skills for final control:
- external measurement of pelvis
- Leopold maneuvers, measurement of conjugate vera
- determination of gestational term
- determination of gestational age of fetus and mass of the fetus
- determination of date of delivery
- management of normal delivery
- giving of the obstetrical aid in delivery and during the fetus
- estimation of the newborn’s conditions according to Apgar scale
- primary care of newborn
- management of medical documentation
Assessment of student’s knowledge
№
1.
2.
3.
4.
5.
6.
7.
8.
9.
Theme
Bone Pelvis. Fetus as an object of labor.
Physiology of pregnancy. Perinatal care of fetus. Methods of
examination of pregnant women. Obstetrics terminology
Physiology of labor. Anesthesia in labor.
Physiology of puerperium. Physiology of newborn.
Breech presentation. Malpresentations. Contracted pelvis
Abnormalities of conceptus’ development. Multifetal pregnancy.
Malpresentations of fetus.
Diagnostic methods of well-being of fetus. Placental insufficiency.
Rh-izoimmunisation of fetus. Disorders of neonatal period. Asphyxia
of the newborn. Methods of resuscitation of the infants.”
Defense of educational history of labor.
Points
12
12
12
12
12
12
12
12
12
Independent students’ work
12
Total current study work
120
Final modular control I.
80
Total
200
Student can be allowed to pass final modular control in case he/she fulfilled study
program and received at least 72 (9x8) points during practical classes. Final
modular control can be described as “passed” in case student received at least 50
of 80 points.
Criteria of marks and students’ knowledge assessment on obstetrics for 4th year
students of medical faculty
Student receives mark “excellent” in case he/she learned theoretical
material comprehensively and thoroughly, is able to perform correct taking of
anamnesis/ complains and physical examination of pregnant women, parturient
women and women in puerperium. He/she has to be able to perform vaginal
examination. The student has to be able to make a plan of diagnostics and
treatment of woman, depending of present pathology, and to perform all
manipulations, requested by practical skills list. Changing of task or additional
questions do not cause any difficulties for student. Corresponds to 12 points.
Student receives mark “good” in case he/she learned theoretical material
deeply enough, is able to perform taking of anamnesis/ complains and physical
examination of pregnant women, parturient women and women in puerperium.
The student has to be able to make a plan of diagnostics and treatment of
woman, depending of present pathology, and to perform manipulations,
requested by practical skills list. Few inaccuracies in answer or in clinical cases
solving may be assumed. Corresponds to 10 points.
Student receives mark “satisfactorily” in case he/she learned basic
theoretical material, is able to perform elements of taking of anamnesis/
complains and physical examination of pregnant women, parturient women and
women in puerperium. The student has difficulties in making a plan of diagnostics
and treatment of woman, and in performing manipulations, requested by
practical skills list. Corresponds to 8 points.
Student receives mark “unsatisfactorily” in case he/she didn’t learn
theoretical material, is not able to perform taking of anamnesis/ complains and
physical examination of pregnant women, parturient women and women in
puerperium, is not able to make a plan of diagnostics and treatment of woman,
depending of present pathology, and to perform manipulations, requested by
practical skills list. Major inaccuracies in answer or in clinical cases solving can be
reason for not-passing the credit. In case student gained less then minimum sum
of points, he/she receives mark “unsatisfactorily with the mandatory repeated
course” and has to learn the module again (see table below).
scale ECTS
А (excellent)
В (very well)
С (good)
D (satisfactorily)
Е (poorly)
FX
F
National scale
excellent
good
satisfactorily
unsatisfactorily
with possibility of
repeated
drafting
unsatisfactorily
with the mandatory
repeated course
Scale BSMU (in balls)
180-200
165-179
150-164
135-149
120-134
70-119
1-69
Recommended literature
Main:
1. Danforth's Obstetrics and gynaecology. - Seventh edition.- 1994.
2. Obstetrics and gynaecology. Williams & Wilkins Waverly Company. - Third
Edition.- 1998.
3. Basic Gynecology and Obstetrics. - Norman F. Gant, F. Gary Cunningham. 1993.
4. Clinical Obstetrics of Fetus and Mother – E. Albert Reece&John Hobbins. –
Third Edition. – Blackwell publishing. – 2007.
5. Obstetrics Illustrated. – Kevin P. Hanretty. – Sixth Edition. – Churchill
Livingstone. - 2003.
6. Manual on Obstetrics. – Arthur T. Evans. – Seventh Edition. - Lippincott
Williams & Wilkins. – 2007.
Additional:
1. Акушерство за ред. В.І. Грищенка -Харків, Основа 1996.-608с.
2. Гінекологія за ред. В.І. Грищенка -Харків, Основа 1996.-728с.
3. Неотложные состояния в акушерстве и гинекологии / Г.К. Степанковская
(ред.). — К. : Здоров'я, 2000. — 672с.
4. Бодяжина В.И. Гинекология.- М.: Медицина, 1977.- 416 с.
5. Бодяжина В.И., Жмакин К.Н., Кирющенков А.П. Акушерство.- М.:
Медицина, 1986. - 496 с.
6. Запорожан В.М., Цегельський М.Р., Рожковська Н.М. Акушерство і
гінекологія. Підручник : у 2-х томах. Т.1. – Одеса: Одес. держ. мед. ун-т, 2005.472с.
7. Бохман Я.В. Руководство по онкогинекологии. - М.: Медицина, 1989.- 464
с
8. Шехтман М.М Руководство по экстрагенитальной патологии у
беременных.-М.: Триада-Х,1999.- 812с.
9. Грищенко В.И. и соавт. Течение беременности и родов при
экстрагенитальных заболеваниях. - Харьков,1992.-190с.
10. Грищенко В.И., Щербина Н.А., Гузь С.В. Перинатальная гипоксия.Харьков, 1993.-123с.
11. Грищенко В.І. та соавт. Комп,ютернi системи в акушерствi i гiнекологiї.Навчальний посiбник. - Харкiв,1993.-95с.
12. Рембез И.Н. Оперативная гинекология.- К.: Здоровья, 1985.-256 с.
13. Савельева Г.М. Эндоскопия в гинекологии.- М.: Медицина, 1983.- 199 с.
14. Савельева Г.М. Акушерство и гинекология .-ГЭОТАР Медицина,1997.735с.
15. Тимошенко Л.В. Практическая гинекология.- К: Здоровья, 1988.- 320с.
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стаціонарної акушерсько-гінекологічної та неонатологічної допомоги в
Україні”.
17. Наказ МОЗ України № 503 від 28.12.2002р. “Про удосконалення
амбулаторної акушерсько-гінекологічної допомоги в Україні”.
18. Наказ МОЗ України № 582 від 15.12.2003р. “Про затвердження клінічних
протоколів з акушерської та гінекологічної допомоги”.
19. Наказ МОЗ України № 676 від 31.12.2004р. “Про затвердження клінічних
протоколів з акушерської та гінекологічної допомоги”.
20. Наказ МОЗ України № 782 від 29.12.2005р. “Про затвердження клінічних
протоколів з акушерської та гінекологічної допомоги ”.
21. Наказ МОЗ України № 59 від 10.02.2003р. “Про удосконалення заходів
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22. Наказ МОЗ України № 111 від 28.06.1994р. “Про затвердження інструкцій
про порядок проведеня операції штучного переривання вагітності та про
порядок проведення операції штучного переривання вагітності методом
вакуумаспірації”.
23. Наказ МОЗ України № 641/84 від 31.12.2003р. “Про удосконалення
медико-генетичної допомоги в Україні”.
24. Наказ МОЗ України № 194 від 6.05.2003р. “Про затвердження галузевої
програми “Первинна реанімація новонароджених на 2003-2006 роки”.
25. Наказ МОЗ України № 539 від 4.08.2006р. “Про організацію діяльності
служби планування сім’ї та охорони репродуктивного здоров’я в Україні”.
26. Наказ МОЗ України № 584 від 29.08.2006р. “Про затвердження Протоколу
медичного догляду за новонародженою дитиною з малою масою при
народженні”.
27. Наказ МОЗ України № 899 від 27.12.2006р. “Про затвердження клінічного
протоколу з акушерської допомоги “Тазове передлежання плода”.
28. Наказ МОЗ України № 900 від 27.12.2006р. “Дистрес плода при вагітності
та під час пологів”.
29. Наказ МОЗ України № 901 від 27.12.2006р. “Про затвердження клінічного
протоколу з акушерської допомоги “Переношена вагітність”.
30. Наказ МОЗ України № 906 від 27.12.2006р. “Про затвердження клінічного
протоколу з акушерської допомоги “Перинатальні інфекції”.